Changing Lanes : Alcohol and Anger

I forgot about "Movie Friday".

Can it be Movie Sunday, please, this week? Let's go with the elastic is better, concept.

As the shrink in the movie Ordinary People once said, and I paraphrase,

We Therapy Docs aren't so into control.

But since today is Sunday and it's a day that a lot of people sit around and watch sports and drink beer (or commercials for next week's Superbowl game--can you believe those Bears?!) I'm going with this post.

Not an A.A. expert, I still appreciate much of the Alcoholics Anonymous program and I know a lot about it. I automatically recommend it to my patients who are problem drinkers based on the success rate in my practice. I've met dozens of people who got sober and stayed sober with A.A.

But it's better with therapy. The therapy part is key for certain issues, one being anger. In A.A. meetings people talk a lot about rage.

Therapy docs do, too. I used to want a vanity plate that said Get Therapy to speak to the road ragers. Can you understand getting angry behind the wheel of a car? Does THAT make sense? But there were too many letters in G-E-T-T-H-E-R-A-P-Y.

Which brings us to alcohol, anger, and pretty soon the movie Changing Lanes.

A.A. sponsors, the closest thing to therapists for many people, are not licensed, trained therapists of any kind. They're fabulous people, have usually survived their own sobriety, give generously of their time, and just like in the movies they can be unbelievably heroic and often step in with the proper language and interventions that makes the difference between a sponsee's decision to drink or not to drink.

But successful sobriety is all about the sponsee's (the person working the program) committment to sobriety, work on the 12 Steps, and meeting attendance. Sponsors aren't supposed to be therapists. My understanding is that they are people who can help you work the steps and they don't want to be therapists. They generally recommend therapy, as long as it isn't a psycho-pharmacologic therapy. Unless things have changed, A.A. is a little down on meds.

But a lot of people don't go to therapy because they get so much out of A.A. and similar programs. A.A. is free. (You can go, you know, to the community mental health centers or many university clinics and pay for treatment on a sliding scale and still go to A.A. if you want. Maybe should.)

The A.A. program was developed in the 1930's, well before we had a decent scientific understanding of emotions and the brain. In those early A.A. meetings people sat around and talked about their dysfunctional families, and people who had ragers in their families had the best stories to tell.

Even now, at some meetings people talk about the rage-aholic(s) in the family as if it is understood that this is a genetic disease, raging.

A rage-aholic is theoretically a person addicted to anger, consumed by it.

It is true, people may seem to be rage-aholics, unable to control their anger. It may even be true, that some people are so emotionally handicapped that they need something to calm the wild beast. For A.A. people that "something" would be community service, a relationship with a higher power, working a program. Therapy docs would recommend medication, cognitive therapy, family therapy, even psychodynamic or ANY kind of therapy along with lots of psycho-education.

Face it, sometimes incarceration is the inevitable resolution of the State for people with anger control problems.

Therapy docs look at "rage-aholics" as folks who might also be mentally ill, might suffer from bi-polar disorder, paranoid schizophrenia, a severe personality disorder or three (certainly sociopathy), eating disorders, alcoholism or other substance abuse disorders.

Or they may have been raised by individuals with these diagnoses, people who raised them with rage, in a sense communicating "permission" to be a rager.

So saying someone is a rager doesn't say very much to a therapy doc about how to treat that person. There's so much more to know.

It says (it should say) to the average Joe, Avoid that Individual.

Or get that person to a therapy doc for a diagnosis and treatment.

So recently I watched Changing Lanes again on cable. I loved it in the theater, remember not liking William Hurt and his sponsoring style--punitive, a style I've heard about more than a few times as characteristic of sponsors, along with a touch of shaming .

I've mentioned before that shaming is destructive. No good can come of it. Among other things, a person who has been shamed becomes less communicative, less emotionally available. Self-esteem goes down, self-destructive habits go up.

I hope if you're a sponsor and you're reading this and disagree with what I say about A.A. or sponsors that you'll let me have it between the teeth in the comments. Make that,

I hope if you're a sponsor and you're reading this and disagree that you'll write me a Comment and assert yourself. You can be anonymous :)

But the alcoholic in the movie, Doyle Gipson, played by Samuel Jackson, is working very hard to become a stable human being, one who is not affected by the poisons of alcohol. He goes to A. A. meetings and his "new leaf" behavior is generally deliberate, the type of moral, thoughtful, considerate behavior that A.A. teaches so well.

See, one of the amazing things about this form of rehabilitation is that the language of A.A. inspires positive behavioral and personality change. The language reconnects with the best messages your parents ever taught you, the ethics you learned in school. It syncs nicely with major religious teachings, the emphasis of life being best lived with kindness, patience, and putting out good karma (what goes around, comes around).

So Doyle is doing that in the movie and we like him much more than his anti-hero nemesis, the rich, white, lawyer (played by Ben Affleck) whose fancy car collides with Doyle's beater on a highway during bad weather the very day of Doyle's Big Day in Court.

The Ben Affleck character storms off without leaving identification or insurance but forgets a most important file. Doyle is stuck with "better luck next time."

Doyle misses his hearing because of the accident and loses his wife and children who will now have court permission to move to the other end of the country. But he has that file.

The plot gets pretty good and the tension between Samual Jackson and Ben Affleck becomes palpable, the anger, the rage, the revenge fascinate. How will they resolve this and will Doyle lose his sobriety?

He has already turned into a "dry drunk" before our eyes, meaning his behavior is unpredictable, unstable, and his wife and children are afraid of him again even though he's sober.

THIS is the pattern I see so often, this "dry drunk" thing, acting drunk (irrational and emotional) while not under the influence of alcohol. Program thumpers will say that of course, if people do not work a program, that they WILL NOT CHANGE even if they get sober. They will behave the same way they did as drinkers, uninhibited and lacking in empathy for the pain they cause others. ANGRY.

There is no hard evidence to support this contention, mainly because it's hard to measure A.A.'s interventions in outcome research. It's an anonymous program.

We do know, however, that alcohol is associated with wild, uninhibited behavior because it has that disinhibiting effect upon the limbic system. Without alcohol, behavior should be and is under better conscious control for most of us.

But there other variables, like the ones I mentioned above, like mental illness (the Axis I disorders), personality (the Axis II disorders), family culture and dynamics, and the ecosystem (everything else that affects our minds and bodies).

And we know that anger per se isn't just a function of being drunk. We all get angry. Many of us are less in touch with our anger than others, especially if it was frowned upon in the family, or if only the parents were allowed to be angry. I'm certainly out of touch with mine, and I'd like to think it's from years of cultural proscription against anger and violence, a collective memory phenomenon, in the DNA.

So no, you won't be hurling insults at one another in my office. I don't need that, nor do you, so you'll have to learn another way to communicate with one another. Oh yeah, that's MY job, to teach you. Touche'.

But depending upon how we've been socialized to express aggression and our individual character traits, anger can come out as violence, either verbal or physical. Or it can be repressed. Or it can present anywhere on the continuum below.

[By the way, I see both physical and verbal violence as forms of emotional violence. The center, where I put the slash, is assertiveness, speaking dispassionately, rationally, about just the facts of a situation.]

I won't give away the ending of the movie because it's worth watching.
But if you're a person who has trouble controlling your anger, or if you live with someone who is unstable in that way, it's certainly a good idea to get therapy for it, to learn how to be assertive and when.

Left untreated, the violent expression of anger can be unforgettable, dire. We do have medications and psychotherapies to treat it, so there is really no need for the pain. Both people are hurt within an angry interaction. The aggressor loses the respect and real affection of the victim. The victim may believe he or she deserves maltreatment.

Suggestions about anger in relationships:
1. If it is you that is angry, don't talk to anyone until you're not as hot. I can't emphasize enough the importance of this time to distance and calm down BEFORE having ANY conversation with anyone.

2. If you do talk to someone while you are angry, make sure that person is someone who will be unconditionally supportive and will let you vent. Be sure there's no way you will become violent under any circumstances in any way (emotionally/physically/verbally).

3. When you are direct with the person you're angry at, don't be accusatory or blaming, stay assertive. (Read other posts)

And if someone else is angry?

4. Wait until that person is NOT angry to talk to him/her. And even then, be careful and have an exit strategy in place if that person has been violent in the past.

Is that so hard to do? Yeah, actually it is. So therapy, Al Anon (the program for family members of individuals with alcohol addictions), ANY outside support that strives to eliminate domestic violence is pretty key.

5. The best advice? Don't handle a partner's or your own raging alone. Get help on this one before someone gets hurt.

Copyright 2007, TherapyDoc